Early screening and diagnosis of gestational diabetes mellitus (GDM) and its impact on perinatal outcomes.

AIMS: To compare the maternal and neonatal outcomes following early diagnosis compared with routine diagnosis of gestational diabetes (GDM). METHODS: In this observational study, 3494 women were categorised by weeks of gestation at GDM diagnosis: early GDM (≤20 weeks) and routine GDM (>20 weeks). The early GDM group was further divided by treatment commencement as immediate (<12 weeks) and delayed (12-20 weeks) and by diagnostic fasting blood glucose as higher-FBG (5.3-6.0 mmol/L) and lower-FBG group (FBG 5.1-5.2 mmol/L). Primary outcomes were large for gestational age (LGA) and small for gestational age (SGA). Generalized linear models used to calculate risk ratios and adjusted for confounding. RESULTS: Risk ratios (RR) for LGA and SGA were similar for early versus routine diagnosis, and immediate versus delayed treatment. The higher-FBG immediate treatment group had a lower risk of newborn respiratory distress (RR 0.52, 95 %CI 0.34, 0.81) and emergency caesarean (RR 0.55, 95 %CI 0.34, 0.88) compared to the higher-FBG delayed treatment group. Among the lower-FBG group, no such benefits were seen. CONCLUSIONS: Fasting glucose levels modified the effects of early treatment of GDM where a higher-FBG with immediate treatment appears to reduce perinatal complications, but treating women with lower-FBG early has no benefits.

Assessing the effect of anthocyanins through diet and supplementation on cognitive function in older adults at risk for dementia: protocol for a randomised controlled trial.

INTRODUCTION: Promising evidence is emerging for the procognitive, anti-inflammatory and neuroprotective properties of dietary flavonoids, particularly anthocyanins that provide red, purple and blue plant pigments. METHODS AND ANALYSIS: The 'Food for Thought' study is a multicentre, 6-month randomised, parallel 3-arm clinical trial. Its primary aim is to investigate whether anthocyanin consumption, either through diet or supplementation, can prevent memory loss progression and improve inflammatory and cardiovascular health in older adults at risk for dementia. Eligible participants will include those aged 60-85 years with a diagnosis of amnestic mild cognitive impairment or with a self-referral of memory concerns and scoring ≤13 on the Memory Index Score within the Telephone Montreal Cognitive Assessment screening test. Participants will be randomised to one of three arms: High anthocyanin ('purple foods') diet (aiming for a target of 250 mg anthocyanins/day); freeze-dried product derived from blackcurrants (250 mg anthocyanins/day); or control (coloured maltose powder). The primary outcome is auditory anterograde memory functioning assessed by the Buschke and Grober Free and Cued Selective Reminding Test-Immediate Recall. Secondary outcomes are additional cognitive functions including processing speed, working memory, aspects of executive functioning (attentional shifting and word generativity) and premorbid estimate as well as subjective memory problems and self-reported depression symptoms. Additional secondary outcomes are blood pressure, inflammatory biomarkers, brain-derived neurotrophic factor, fatty acid profile, apolipoprotein E and polyphenol metabolites, gut microbiota composition and function and vascular and microvascular endothelial function tests. Repeated measures analysis of variance and/or mixed linear modelling will evaluate changes over time, with the inclusion of covariates. ETHICS AND DISSEMINATION: Ethics approval has been obtained from the Greater Western Human Research Ethics Committee (2021/ETH12083). A Consumer Advisory Group was established to guide and review the protocol and dissemination strategy. The results of this trial are intended to be published in a peer-reviewed journal. TRIAL SPONSOR: National Health and Medical Research Centre Dementia Collaborative Research Centre.Start date of clinical trial: 02 September 2022.Expected end date: 11 October 2024. TRIAL REGISTRATION NUMBER: ACTRN12622000065796.

Contemporary national and international guidelines on physical activity and sedentary behaviour for people living with chronic conditions, disability and advanced age: a scoping review.

OBJECTIVES: Physical activity guidelines inform policy and practice in promoting healthier lifestyles. The WHO advocates for distinct recommendations for each country to address variation in needs, resources and context. Specific regional recommendations for three underactive populations facing unique barriers to movement are lacking-people with chronic conditions, disability and advanced age. We review which countries/regions provide specific physical activity guidelines for these populations to identify deficiencies in meeting WHO recommendations and inform future directions for guideline development. DESIGN: Scoping review. DATA SOURCES: OVID Medline, PubMed, Scopus, Embase, Web of Science, Google Scholar, ProQuest, CINAHL, Google searches, targeted websites. ELIGIBILITY CRITERIA: Data sources were searched from database inception to September 2023 to identify community-facing physical activity guidelines at the national/international level for these populations. We recorded, summarised and analysed physical activity guideline recommendations extracted from published guideline documents, organised by population and country/region. RESULTS: 66 articles were identified, addressing 28 distinct countries/regions, including four international guidelines, published from 2009 to 2023. The WHO guidelines were adopted by 19 countries and the European Union. Across all regions, a lack of specific advice was identified for individuals with chronic conditions (46%), disability (46%) and advanced age (11%). Advice for chronic conditions and disability commonly replicated general adult population advice. CONCLUSION: Many countries/regions do not produce physical activity guidelines specific to populations with chronic conditions and disability. As such, a large proportion of countries/regions failed to meet WHO recommendations, highlighting a lack of customised advice to address unique barriers faced by vulnerable populations.

Timing of Moderate to Vigorous Physical Activity, Mortality, Cardiovascular Disease, and Microvascular Disease in Adults With Obesity.

OBJECTIVE: To assess the association between timing of aerobic moderate to vigorous physical activity (MVPA) and risk of cardiovascular disease (CVD), microvascular disease (MVD), and all-cause mortality in adults with obesity and a subset with obesity and type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS: Participants included adults with obesity (BMI ≥30 kg/m2) and a subset of those with T2D from the UK Biobank accelerometry substudy. Aerobic MVPA was defined as bouts of MVPA lasting ≥3 continuous minutes. Participants were categorized into morning, afternoon, or evening MVPA based on when they undertook the majority of their aerobic MVPA. The reference group included participants with an average of less than one aerobic MVPA bout per day. Analyses were adjusted for established and potential confounders. RESULTS: The core sample included 29,836 adults with obesity, with a mean age of 62.2 (SD 7.7) years. Over a mean follow-up period of 7.9 (SD 0.8) years, 1,425 deaths, 3,980 CVD events, and 2,162 MVD events occurred. Compared with activity in the reference group, evening MVPA was associated with the lowest risk of mortality (hazard ratio [HR] 0.39; 95% CI 0.27, 0.55), whereas afternoon (HR 0.60; 95% CI 0.51, 0.71) and morning MVPA (HR 0.67; 95% CI 0.56, 0.79) demonstrated significant but weaker associations. Similar patterns were observed for CVD and MVD incidence, with evening MVPA associated with the lowest risk of CVD (HR 0.64; 95% CI 0.54, 0.75) and MVD (HR 0.76; 95% CI 0.63, 0.92). Findings were similar in the T2D subset (n = 2,995). CONCLUSIONS: Aerobic MVPA bouts undertaken in the evening were associated with the lowest risk of mortality, CVD, and MVD. Timing of physical activity may play a role in the future of obesity and T2D management.

Diagnosis to Delivery: A Randomized Clinical Trial of Postmeal Walking in Women with Gestational Diabetes.

PURPOSE: The aim of this study was to determine whether advice to perform postmeal walking could be an effective and feasible alternate to standard care continuous walking for the management of gestational diabetes (GDM). METHODS: Forty women with GDM were randomized between 28 and 30 wk of gestation into either standard care (CTL; 30-min continuous walking, most days per week) or standard care with advice to PMW (daily 10-min walks after three main meals) for ~7 wk. The primary outcome for this randomized controlled trial was postprandial glucose assessed by continuous glucose monitors. Continuous glucose monitor and ActivPAL inclinometers (physical activity parameters) were each worn for 7 d at ~28 and ~35 wk gestation. Delivery outcomes were also collected. A linear mixed model compared the changes across time between groups. RESULTS: Twenty-six women (PMW: n = 12, CTL: n = 14; age 34 ± 5 y) completed the trial. Mean 3 h postprandial glucose at dinner was higher in the PMW versus CTL group at baseline and across the intervention (main effect group, P = 0.04). Twenty-four hours, nocturnal, and fasting glucose were similar between groups. The PMW group spent ~57 min·d -1 more time sedentary and ~11 min·d -1 less time stepping versus CTL (main effect group: P = 0.02 and 0.05). Adherence to the prescribed 30 min·d -1 of physical activity was high, regardless of whether accumulated as 3 × 10-min or one single bout of walking. CONCLUSIONS: Distributing activity as 10-min bouts after main meals did not improve postprandial glucose outcomes compared with standard-care control. More research on the optimal duration and intensity of postmeal walks to improve postprandial responses are needed. Strategies that mitigate sedentary time and increase the minutes of physical activity accumulated across the day in pregnancy are also warranted.

Using Continuous Glucose Monitoring to Prescribe a Time to Exercise for Individuals with Type 2 Diabetes.

This study examines the potential utility of using continuous glucose monitoring (CGM) to prescribe an exercise time to target peak hyperglycaemia in people with type 2 diabetes (T2D). The main aim is to test the feasibility of prescribing an individualised daily exercise time, based on the time of CGM-derived peak glucose, for people with T2D. Thirty-five individuals with T2D (HbA1c: 7.2 ± 0.8%; age: 64 ± 7 y; BMI: 29.2 ± 5.2 kg/m2) were recruited and randomised to one of two 14 d exercise interventions: i) ExPeak (daily exercise starting 30 min before peak hyperglycaemia) or placebo active control NonPeak (daily exercise starting 90 min after peak hyperglycaemia). The time of peak hyperglycaemia was determined via a two-week baseline CGM. A CGM, accelerometer, and heart rate monitor were worn during the free-living interventions to objectively measure glycaemic control outcomes, moderate-to-vigorous intensity physical activity (MVPA), and exercise adherence for future translation in a clinical trial. Participation in MVPA increased 26% when an exercise time was prescribed compared to habitual baseline (p < 0.01), with no difference between intervention groups (p > 0.26). The total MVPA increased by 10 min/day during the intervention compared to the baseline (baseline: 23 ± 14 min/d vs. intervention: 33 ± 16 min/d, main effect of time p = 0.03, no interaction). The change in peak blood glucose (mmol/L) was similar between the ExPeak (-0.44 ± 1.6 mmol/L, d = 0.21) and the NonPeak (-0.39 ± 1.5 mmol/L, d = 0.16) intervention groups (p = 0.92). Prescribing an exercise time based on CGM may increase daily participation in physical activity in people with type 2 diabetes; however, further studies are needed to test the long-term impact of this approach.

Impact of a Low-Carbohydrate Compared with Low-Fat Breakfast on Blood Glucose Control in Type 2 Diabetes: A Randomized Trial.

BACKGROUND: In type 2 diabetes (T2D), consuming carbohydrates results in a rapid and large increase in blood glucose, particularly in the morning when glucose intolerance is highest. OBJECTIVES: We investigated if a low-carbohydrate (LC) breakfast (∼465 kcal: 25 g protein, 8 g carbohydrates, and 37 g fat) could improve glucose control in people with T2D when compared with a low-fat control (CTL) breakfast (∼450 kcal:20 g protein, 56 g carbohydrates, and 15 g fat). METHODS: Participants with T2D (N = 121, 53% women, mean age 64 y) completed a remote 3-month parallel-group randomized controlled trial comparing a LC with standard low-fat guideline CTL breakfast. The change in HbA1c was the prespecified primary outcome. Continuous glucose monitoring, self-reported anthropometrics, and dietary information were collected for an intention-to-treat analysis. RESULTS: HbA1c was reduced (-0.3%; 95% CI: -0.4%, -0.1%) after 12 wks of a LC breakfast, but the between-group difference in HbA1c was of borderline statistical significance (-0.2; 95% CI: -0.4, 0.0; P = 0.06). Self-reported total daily energy (-242 kcal; 95% CI: -460, -24 kcal; P = 0.03) and carbohydrate (-73 g; 95% CI: -101, -44 g; P < 0.01) intake were lower in the LC group but the significance of this difference is unclear. Mean and maximum glucose, area under the curve, glycemic variability, standard deviation, and time above range were all significantly lower, and time in the range was significantly higher, in the LC group compared with CTL (all P < 0.05). CONCLUSIONS: Advice and guidance to consume a LC breakfast appears to be a simple dietary strategy to reduce overall energy and carbohydrate intake and improve several continuous glucose monitoring variables when compared with a CTL breakfast in persons living with T2D. The trial was registered at clinicaltrials.gov as NCT04550468.

Physical Activity, but Not Glycaemic Load, Is Associated with Lower Real-Time Glycaemic Control in Free-Living Women with Gestational Diabetes Mellitus.

Maintaining blood glucose within the target range is the primary treatment goal for women with gestational diabetes mellitus (GDM). Foods with low glycaemic loads are recommended in clinical practice; however, the relative importance of other key lifestyle variables is unexplored. This pilot study explored the associations of glycaemic load, carbohydrates and physical activity parameters on blood glucose concentrations in free-living women with GDM. Twenty-nine women (28-30 weeks gestation, 34 ± 4 years) with GDM were enrolled. Continuous glucose monitoring, physical activity (ActivPAL inclinometer) and dietary intake and dietary quality were measured concurrently for 3 days. Pearson correlation analyses determined the association between glucose levels and lifestyle variables. Despite all receiving the same nutrition education, only 55% of women were following a low glycaemic load diet with a large range of carbohydrate intakes (97-267 g/day). However, the glycaemic load did not correlate with 3-hr postprandial glucose (r2 = 0.021, p = 0.56) or 24-h glucose iAUC (r2 = 0.021, p = 0.58). A significant relationship between total stepping time and lower 24-h glucose iAUC (r2 = 0.308, p = 0.02) and nocturnal glucose (r2 = 0.224, p = 0.05) was found. In free-living women with diet-controlled GDM, more physical activity, i.e., steps accumulated across the day, may be a simple and effective strategy for improving maternal blood glucose concentrations.

The Effect of Exercise on Quality of Life in Type 2 Diabetes: A Systematic Review and Meta-analysis.

BACKGROUND: Exercise is a proven therapy for managing cardiometabolic risk factors in type 2 diabetes (T2D). However, its effects on patient-reported outcome measures such as quality of life (QoL) in people with T2D remain unclear. Consequently, the primary aim of this study was to determine the effect of regular exercise on QoL in adults with T2D. A secondary aim was to determine the effect of different exercise modalities on QoL. The third aim was to determine whether improvements in QoL were associated with improvements in gly'cated hemoglobin (A1C). METHODS: Relevant databases were searched to May 2022. Eligible studies included randomized trials involving ≥2 wk of aerobic and/or resistance exercise and assessed QoL using a purpose-specific tool. Mean differences and 95% confidence intervals (CI) were calculated as standardized mean difference (SMD) or weighted mean difference. A regression analysis was undertaken to examine the interaction between change in QoL with change in A1C. RESULTS: Of the 12,642 studies retrieved, 29 were included involving 2354 participants. Exercise improved QoL when compared with control (SMD, 0.384; 95% CI, 0.257 to 0.512; P < 0.001). Aerobic exercise, alone (SMD, 0.475; 95% CI, 0.295 to 0.655; P < 0.001) or in combination with resistance training (SMD, 0.363; 95% CI, 0.179 to 0.548; P < 0.001) improved QoL, whereas resistance training alone did not. Physical components of health-related QoL (HRQoL) improved with all exercise modalities, but mental components of HRQoL remained unchanged. Exercise improved A1C (mean difference, -0.509%; 95% CI, -0.806% to -0.212%; P = 0.001), and this change was associated with improvements in HRQoL ( ß = -0.305, SE = 0.140, Z = -2.18, P = 0.030). CONCLUSIONS: These results provide robust evidence that regular aerobic exercise alone or in combination with resistance training is effective for improving QoL in adults with T2D. Such improvements seem to be mediated by improvements in physical components of HRQoL and are associated with improved blood glucose control. Further studies should be undertaken to determine the relative importance of exercise duration, intensity, and frequency on patient-reported outcomes such as QoL.

Reducing Sitting Time in Type 1 Diabetes: Considerations and Implications.

Sedentary behaviours are ubiquitous in modern society, with Western populations spending approximately 50% of their waking hours in low levels of energy expenditure. This behaviour is associated with cardiometabolic derangements and increased morbidity and mortality. In individuals living with or at risk of developing type 2 diabetes (T2D), "breaking up" sedentariness by interrupting prolonged periods of sitting has been shown to acutely improve glucose management and cardiometabolic risk factors related to diabetes complications. As such, current guidelines recommend interrupting prolonged periods of sitting with short, frequent activity breaks. However, the evidence underpinning these recommendations remains preliminary and is focussed on those with or at risk of developing T2D, with little information regarding whether and how reducing sedentariness may be effective and safe in those living with type 1 diabetes (T1D). In this review, we discuss the potential application of interventions that target prolonged sitting time in T2D within the context of T1D.

Supports and Barriers to Lifestyle Interventions in Women with Gestational Diabetes Mellitus in Australia: A National Online Survey.

BACKGROUND: Gestational diabetes mellitus (GDM) affects approximately one in six pregnancies, causing a significant burden on maternal and infant health. Lifestyle interventions are first-line therapies to manage blood glucose levels (BGLs) and prevent future cardiometabolic complications. However, women with GDM experience considerable barriers to lifestyle interventions; thus, the aim of this study was to determine how women with GDM manage their condition and to identify the primary supports and barriers to lifestyle intervention participation. METHODS: An online cross-sectional survey of women in Australia with a history of GDM was conducted. Questions included participant demographics, strategies used to manage BGLs, physical activity and dietary habits, and barriers and supports to lifestyle interventions. RESULTS: A total of 665 individuals consented and responded to the advertisement, of which 564 were eligible and provided partial or complete responses to the survey questions. Most respondents were between 35 and 39 years of age (35.5%), not pregnant (75.4%), working part-time (26.7%), university-educated (58.0%), and had only one child (40.1%). Most respondents managed their BGLs through diet (88.3%), with "low-carbohydrate" diets being the most popular (72.3%), and 46.2% of respondents were undertaking insulin therapy. Only 42.2% and 19.8% of respondents reported meeting the aerobic and strengthening exercise recommendations, respectively. Women with one child or currently pregnant expecting their first child were 1.51 times more likely (95% CI, 1.02, 2.25) to meet the aerobic exercise recommendations than those with two or more children. The most common reported barriers to lifestyle intervention participation were "lack of time" (71.4%) and "childcare" commitments (57.7%). Lifestyle interventions delivered between 6 and 12 months postpartum (59.0%), involving an exercise program (82.6%), and delivered one-on-one were the most popular (64.9%). CONCLUSION: Most women report managing their GDM with lifestyle strategies. The most common strategies reported involve approaches not currently included in the clinical practice guidelines such as reducing carbohydrate consumption. Furthermore, despite being willing to participate in lifestyle interventions, respondents report significant barriers, including lack of time and childcare commitments, whereas mentioned supports included having an online format. Lifestyle interventions for women with a history of GDM should be designed in a manner that is both tailored to the individual and considerate of existing barriers and supports to participation.

Need and Interest in Nature Prescriptions to Protect Cardiovascular and Mental Health: A Nationally-Representative Study With Insights for Future Randomised Trials.

OBJECTIVE: "Nature prescriptions" are increasingly being adopted by health sectors as an adjunct to standard care to attend to health and social needs. We investigated levels of need and interest in nature prescriptions in adults with cardiovascular diseases, psychological distress and concomitants (e.g. physical inactivity, sedentary behaviour, obesity, loneliness, burn-out). METHODS: A nationally-representative survey of 3,319 adults across all states and territories of Australia was completed in February 2021 (response 84.0%). Participants were classified across 15 target groups using validated health indicators and surveyed on (1) time and frequency of visits to green and blue spaces (nature spaces), (2) interest in a nature prescription, and (3) potential confounders (e.g. age, income). Analyses were done using weighted logistic regressions. RESULTS: The sample was 50.5% female, 52.0% were aged ≥45 years, 15.2% were living alone and 19.3% were born overseas in non-English-speaking countries. Two-thirds of the sample spent 2 hours or more a week in nature, but these levels were generally lower in target groups (e.g. 57.7% in adults with type 2 diabetes). Most participants (81.9%) were interested in a nature prescription, even among those spending fewer than 2 hours a week in nature (76.4%). For example, 2 hours a week or more in nature was lowest among sedentary adults (36.9%) yet interest in nature prescriptions in this group was still high (74.0%). Lower levels of nature contact in target groups was not explained by differences in access to or preference for local nature spaces. CONCLUSIONS: High levels of interest in nature prescriptions amid low levels of nature contact in many target health groups provides impetus for developing randomised trials of interventions that enable people to spend more time in nature. These findings can inform intervention co-design processes with a wide range of community stakeholders, end-users in target health groups, and the health professionals who support them.

Systematic literature review: should a bedtime snack be used to treat hyperglycemia in type 2 diabetes?

BACKGROUND: Consuming a bedtime snack is often recommended for people with type 2 diabetes. OBJECTIVE: This systematic review aims to evaluate the evidence from intervention studies to determine whether consuming a bedtime snack improves fasting hyperglycemia and/or overall glycemic control in individuals with type 2 diabetes. METHODS: PubMed, Medline (EBSCO), Cochrane Library, and CINAHL Plus (EBSCO) databases were searched until 20 July, 2022. We included prospective studies in people with type 2 diabetes or prediabetes that included the intervention of a bedtime snack, consumed >30 min after dinner and <2 h before bed and reported glycemic outcomes. RESULTS: The systematic review included 16 studies. There was no consistent relationship between consumption of a bedtime snack and improved glycemic control, especially when a no-snack control was included. Of the 4 studies that included the use of corn starch, a low dose seemed to have benefits over high-dose corn starch in terms of improved nocturnal and fasting glucose concentrations. CONCLUSIONS: Current advice to consume a bedtime snack is based on a limited number of intervention studies that often do not include a no-snack control, nor have used a feasible bedtime snack option that could be translated into everyday clinical practice. Further research is needed in type 2 diabetes patients treated with or without insulin. This review was registered at the Prospective Register of Systematic Reviews (PROSPERO) as CRD42020182523.

Three short postmeal walks as an alternate therapy to continuous walking for women with gestational diabetes.

The purpose of this study was to determine whether postmeal walking (PMW, breaking up exercise into short bouts after meals) is an effective and feasible alternative to continuous walking for the management of gestational diabetes. Forty-one women with gestational diabetes were randomised between weeks 28-30 gestation to either standard care (30 minutes continuous exercise) or standard care with PMW (10 minutes of walking after breakfast, lunch, and dinner). Continuous glucose and activity monitors were worn to measure glycaemic control and adherence during 3 days of standard care (baseline) followed by 3 days of postmeal or continuous walking. A linear mixed model analysed the changes from baseline between postmeal and continuous walking, as an average of the 3-day periods. Thirty-two women (PMW n = 17: control n = 15, 33 ± 5 years, body mass index 25 ± 4 kg·m-2) completed the trial. Postprandial and overnight glucose concentrations were similar between PMW and control; both interventions improved from baseline. There was no difference in adherence between groups; however, PMW completed more minutes of prescribed physical activity across baseline and intervention days compared to the continuous walking standard-care group. Preliminary findings from this proof-of-concept study suggest PMW could be a promising alternative to, and work interchangeably with, traditional advice to perform continuous moderate-intensity physical activity in women with gestational diabetes. Novelty: Three 10-minute postmeal walks may be comparable to 30 minutes continuous walking for glucose control in women with gestational diabetes. Accumulating activity in short bouts after meals is a feasible alternate to continuous exercise for women with gestational diabetes.

'Beyond the Bump': an online wellbeing and lifestyle pilot program during COVID-19 for first year postpartum mothers: a research article.

BACKGROUND: Establishing a healthy lifestyle post-delivery is pivotal to reduce the incidence of chronic diseases. Due to COVID-19 restrictions, access to postpartum health programs has been increasingly difficult. The aim of this study was to inform, develop and evaluate Beyond the Bump (BtB); an online program to improve access to health and wellbeing education and support for physical activity in the postpartum. METHODS: A three-phase mixed-methods design of a 10-week Australia-wide online pilot program during COVID-19 with women less than 1 year postpartum and their primary care health professionals was utilised. Phase-one: needs assessment focus groups and interviews. Phase-two: BtB program implementation pre-post health measures survey, attendance and engagement with the program. Phase-three: program evaluation with feedback surveys and interviews. RESULTS: Women (n = 12) and health professionals (n = 16) expressed strong need for a postpartum program with access to education from experts on exercise, pelvic floor, sleep and baby nutrition. Despite BtB being developed from women's suggestions (including time-of-day 'morning'), attendance to all ten sessions was poor (of 162 registrations; 23% participated in the first session and 5% in the last session). Barriers to attendance included 'too busy',' forgot' and 'topic not relevant for age of child'. 88% of women reported the education as the most enjoyable component of the program. 100% (n = 26) of women interviewed would recommend the program to a friend. CONCLUSIONS: There is a continuing need for postpartum support. Online programs with access to expert education and exercise were reported to be of significant interest and value. However, more research is needed to improve the uptake and value placed on mothers' wellbeing and physical activity.

Metformin: A promising option for the management of gestational diabetes mellitus - Exploring the benefits, challenges and clinical needs in the current management of gestational diabetes mellitus.

The incidence of gestational diabetes mellitus (GDM) is increasing. One in three women require insulin to achieve glycaemic targets in GDM. However, it is unclear whether insulin therapy alone is the most effective treatment for all women in achieving glycaemic control and preventing adverse pregnancy outcomes. Although no oral hypoglycaemic agents are approved for pregnancy in Australia, recent research indicates that metformin is effective in preventing adverse perinatal outcomes and may even have possible benefits in the long term. Furthermore, there appears to be a specific role for both metformin and insulin among the GDM population. Metformin provides an option to offer an individualised approach to treat GDM.

Personalising activity to target peak hyperglycaemia and improve cardiometabolic health in people with type 2 diabetes: protocol for a randomised controlled trial.

INTRODUCTION: The benefits of physical activity for glycaemic control in type 2 diabetes (T2D) are well-known. However, whether established glycaemic and cardiovascular benefits can be maximised by exercising at a certain time of day is unknown. Given postprandial glucose peaks contribute to worsening glycated haemoglobin (HbA1c) and cardiovascular risk factors, and that exercise immediately lowers blood glucose, prescribing exercise at a specific time of day to attenuate peak hyperglycaemia may improve glycaemic control and reduce the burden of cardiovascular disease in people with T2D. METHODS AND ANALYSIS: A single-centre randomised controlled trial will be conducted by the University of Wollongong, Australia. Individuals with T2D (n=70, aged 40-75 years, body mass index (BMI): 27-40 kg/m2) will be recruited and randomly allocated (1:1), stratified for sex and insulin, to one of three groups: (1) exercise at time of peak hyperglycaemia (ExPeak, personalised), (2) exercise not at time of peak hyperglycaemia (NonPeak) or (3) waitlist control (WLC, standard care). The trial will be 5 months, comprising an 8-week intervention and 3-month follow-up. Primary outcome is the change in HbA1c preintervention to postintervention. Secondary outcomes include vascular function (endothelial function and arterial stiffness), metabolic control (blood lipids and inflammation) and body composition (anthropometrics and dual-energy X-ray absorptiometry (DEXA)). Tertiary outcomes will examine adherence. ETHICS AND DISSEMINATION: The joint UOW and ISLHD Ethics Committee approved protocol (2019/ETH09856) prospectively registered at the Australian New Zealand Clinical Trials Registry. Written informed consent will be obtained from all eligible individuals prior to commencement of the trial. Study results will be published as peer-reviewed articles, presented at national/international conferences and media reports. TRIAL REGISTRATION NUMBER: ACTRN12619001049167.

Post-exercise Warm or Cold Water Immersion to Augment the Cardiometabolic Benefits of Exercise Training: A Proof of Concept Trial.

We investigated whether substituting the final half within 60-min bouts of exercise with passive warm or cold water immersion would provide similar or greater benefits for cardiometabolic health. Thirty healthy participants were randomized to two of three short-term training interventions in a partial crossover (12 sessions over 14-16 days, 4 week washout): (i) EXS: 60 min cycling 70% maximum heart rate (HRmax), (ii) WWI: 30 min cycling then 30 min warm water (38-40°C) immersion, and/or (iii) CWI: 30 min cycling then 30 min cold water (10-12°C) immersion. Before and after, participants completed a 20 min cycle work trial, V . O2max test, and an Oral Glucose Tolerance Test during which indirect calorimetry was used to measure substrate oxidation and metabolic flexibility (slope of fasting to post-prandial carbohydrate oxidation). Data from twenty two participants (25 ± 5 year, BMI 23 ± 3 kg/m2, Female = 11) were analyzed using a fixed-effects linear mixed model. V . O2max increased more in EXS (interaction p = 0.004) than CWI (95% CI: 1.1, 5.3 mL/kg/min, Cohen's d = 1.35), but not WWI (CI: -0.4, 3.9 mL/kg/min, d = 0.72). Work trial distance and power increased 383 ± 223 m and 20 ± 6 W, respectively, without differences between interventions (interaction both p > 0.68). WWI lowered post-prandial glucose ∼9% (CI -1.9, -0.5 mmol/L; d = 0.63), with no difference between interventions (interaction p = 0.469). Substituting the second half of exercise with WWI provides similar cardiometabolic health benefits to time matched exercise, however, substituting with CWI does not.